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Progestogen-only emergency contraception

The Faculty of Family Planning and Reproductive Health Care shares answers it has given to questions from experienced family planning clinicians

The Faculty of Family Planning and Reproductive Health Care shares answers it has given to questions from experienced family planning clinicians

For women who attend more than 72 hours after unprotected sexual intercourse, can a progestogen-only emergency contraceptive be given and how effective is it?

A large randomised controlled trial by the WHO compared 10mg of mifepristone with single and divided regimens of levonor-gestrel as emergency contraception.

The data showed that when used between 73 and 120 hours after unprotected sex, the divided regimen prevented 60% of expected pregnancies and the single regimen prevented 63%. Very few women were recruited to the trial beyond 72 hours (11% of total) and confidence intervals were wide. The faculty's clinical effectiveness unit (CEU) has previously not recommended the use of progestogen-only emergency contraception routinely beyond 72 hours2. However, more recently, the CEU has suggested that, after counselling, women may consider use of progestogen-only emergency contraception between 73 and 120 hours after unprotected sex3. This use is outside the terms of the product licence.

A copper IUD has a lower failure rate than progestogen-only emergency contraception regardless of the timing of intercourse. A copper IUD can be inserted up to five days (120 hours) after the first episode of unprotected sex or up to five days after the expected date of ovulation in a regular cycle. The CEU recommends that women presenting between 73 and 120 hours after unprotected sex should be informed that a copper IUD is the most effective method of emergency contraception. However, where use of a copper IUD is unacceptable, progestogen-only emergency contraception can be considered and may continue to prevent up to 63% of expected pregnancies.

Are there any contraindications to using progestogen-only emergency contraception twice within the same cycle for under-16s?

No evidence could be found by the CEU regarding contraindications to using progestogen-only emergency contraception more than once in the same cycle for women aged less than 16 years.

CEU guidance on emergency contraception2 suggests progestogen-only emergency contraception can be used more than once in the same cycle. This good practice point applies to women of all ages. Young women should be counselled on the failure rates of hormonal emergency contraception and age should not restrict regular contraception choices, which should also be discussed at the time of initiating emergency contraception.

These question and answers are from Family Planning Masterclass: Evidence-based Answers to 1,000 Questions edited by Gillian Penney, Susan Brechin and Anna Glasier, published by the Royal College of Obstetricians and Gynaecologists, 2006, priced £48. ISBN 1-904752-33-0. To order a copy

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